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ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER:FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br />DBA: AMN Services of New Jersey Limited Liability Company�� <br />AMN Staffing Services, LLC�� <br />DBA: F/K/A Worldview Healthcare, Inc.�� <br />AMN Vision Services, LLC�� <br />DBA: Nursefinders of Verona�� <br />DBA: Medical Express�� <br />Avantas, LLC�� <br />Club Staffing, LLC�� <br />DBA: Advanced Medical Personnel Services LLC�� <br />B.E. Smith International�� <br />DBA: Nursefinders of Rhode Island, LLC�� <br />4 <br />DBA: Nursefinders of Wisconsin, LLC�� <br />DBA: Merritt, Hawkins and Associates of New York, LLC�� <br />DBA: Nursefinders of Missouri, LLC�� <br />DBA: RN Extend�� <br />2 <br />AMN Services of New Hampshire, LLC�� <br />AMN Healthcare, Inc. (AMN)�� <br />San Francisco <br />AMN Allied Services, LLC�� <br />�� <br />AMN Healthcare Services, Inc. (AHS)�� <br />AMN Healthcare Allied, Inc.�� <br />�� <br />�� <br />Full Named Insured Schedule: �� <br />�� <br />Certificate of Liability Insurance <br />DBA: Rx Pro Health of Michigan, LLC�� <br />B.E. Smith, Inc. of Kansas�� <br />CN103083106 <br />DBA: MTI Staffing�� <br />AMN Services of Ohio, Inc.�� <br />DBA: AMN Services of Arizona�� <br />AMN Staffing Services of Alabama, LLC�� <br />DBA: AMN Staffing Services of New Jersey�� <br />AMN Staffing Services, LLC�� <br />B.C.P., Inc. (divested 01/30/2012)�� <br />AMN Workforce Solutions, LLC�� <br />DBA: NurseChoice�� <br />DBA: American Mobile Healthcare�� <br />DBA: Advanced Medical Personnel Service, Inc.�� <br />B.E. Smith, Inc.�� <br />DBA: Nursefinders of New York, LLC�� <br />DBA: Nursefinders of Arizona, LLC�� <br />B4Health, LLC�� <br />DBA: Procertify�� <br />MARSH RISK & INSURANCE SERVICES <br />DBA: Nursefinders of Alabama, LLC�� <br />DBA: Preferred Healthcare Staffing�� <br />12400 High Bluff Drive��AMN Healthcare, Inc.�� <br />�� <br />San Diego,CA 92130-3077�� <br />�� <br />�� <br />�� <br />B.E. Smith Interim Services, Inc.�� <br />DBA: Intech Staffing�� <br />Club Staffing, LLC�� <br />DBA: AMN Healthcare Recruitment Process Outsourcing�� <br />25 <br />DBA: Nursefinders of Cherry Hill�� <br />AMN Services, LLC�� <br />DocuSign Envelope ID: 1DA2E3C9-2103-4259-9AB2-7F86E8F05F9D